Chandigarh

DF-II

CC/409/2019

Jagdamba - Complainant(s)

Versus

Syndicate Bank - Opp.Party(s)

Devinder Kumar Adv.

19 Sep 2022

ORDER

 DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-II,

U.T. CHANDIGARH

 

Consumer Complaint  No	:	409 of 2019
Date  of  Institution	:	23.05.20219
Date   of   Decision	:	19.09.2022

 

 

 

 

 

Jagdamba wife of Late Sh.Ram Avtar through her legal heirs:-

1. Seeta wife of Sh.Ram Rattan daughter of Late Sh.Ram Avtar, r/o Village Ummarpur, Post Kaimau, kaimau, Hardoi, Baghauli, Uttar Pradesh 241122

 

2. Sanjay Kumar son of Late Sh.Ram Avtar, aged about 62 years, resident of House No.3405, Mauli Jagran Complex, Chandigarh.  

 

             …..Complainants

 

Versus

 

1]  Canara Bank (e-Syndicate), SCO No.41, Sector 7, Panchkula, through its Branch Manager.

2]  Canara Bank (e-Syndicate), Regional office: SCO 904, NAC, First Floor, Manimajra, Chandigarh 160101 through its Branch Manager.

3]  United India Insurance Company Limited, IML Building, 2^nd Floor, N.R. Square, Bengaluru 560002 through its Managing Director.  

 

    ….. Opposite Parties

 

 

BEFORE:  SMT.PRITI MALHOTRA        PRESIDING MEMBER 

                    SH.B.M.SHARMA                     MEMBER

                               

For Complainant : Sh.Devinder Kumar, Advocate

For OPs         : Sh.Randeep Singh, Adv. for OPs No.1 & 2

   OP No.3 exparte.

 

PER B.M.SHARMA, MEMBER

         Concisely put, the complainant’s husband late Sh.Ram Avtar was having Bank Account No.82022250000239 with OP No.1 and was insured under scheme of Pardhan mantra Surkasha Bima Yojna (PMSBY) having Policy No.SYNB42913616G201800 (Ann.C-1).  It is stated that as per the said scheme of PMSBY, in case of accident or death arisen due to an accident, then bank is liable to pay the claim to insured or to the nominee of insured.  It is submitted that on 11.6.2018, when insured Ram Avtar was going to Canara Bank, Sector 30, Chandigarh on his bicycle, he was hit by some unknown vehicle when he reached near Transport Light Chowk. The son of the insured took him to Govt. Multispecialty Hospital, Sector 16, Chandigarh where he was treated for accidental injuries and he was discharged on 28.6.2018.  It is stated that as per advice of doctors, the insured was regularly visiting the Hospital for treatment (Ann.C-2), but he could not survive and ultimately died on 11.9.2018 (Ann.C-3).   Thereafter, a claim was lodged with OP Bank under the policy in question along with all requisite documents, but the OPs vide letter dated 6.11.2018 demanded copy of FIR and post-mortem report to process the claim under PMSBSY Scheme (Ann.C-5).

         It is pleaded that the OPs were explained that due to critical condition of insured Ram Avtar, he was immediately admitted to Hospital and provided treatment for accidental injuries, but police was not approached to lodge FIR nor post mortem of the deceased insured Ram Avtar was conducted as he died at home after discharge from Hospital.  It is also pleaded that the OPs never supplied or communicated the policy in question along with its terms & conditions, informing that FIR and post mortem are basic requirement for the claim.  It is stated that the OPs have withhold the claim of the complainant with malafide intentions.  Hence, this complaint has been preferred alleging the said act & conduct of the OPs as deficiency in service. 

 

2]       The OPs No.1 & 2 Bank have filed joint reply and while admitting the factual matrix of the case about issuance of the policy in question (PMSBY Scheme) to deceased Ram Avtar and complainant being her nominee under said policy, stated that answering OPs are not liable to pay the claim to the insured or his nominee without complying with basic requirements as provided under PMSBY Scheme.  It is admitted that husband of complainant met with an accident on 11.6.2018 being matter of record.  It is also admitted that deceased Ram Avtar was admitted to Govt. Multi Speciality Hospital, Sector 16, Chandigarh and was discharged on 28.6.2-019.  It is denied that deceased Ram Avtar did not recover from the treatment of accident.  The lodging of claim by the complainant along with treatment record of deceased insured has been admitted by OPs. It is submitted that OP No.1 vide letter dated 6.11.2018 (Ann.R-2) asked the complainant to submit FIR and Post Mortem Report for processing the claim documents, but the same was not provided.  It is also submitted that being an accident case, without the FIR, the occurrence becomes doubtful and therefore, the FIR and Post Mortem report are basic requirements for processing the claim. It is stated that OP No.2 specifically replied to RTI application of complainant that no separate insurance policy is being issued as the insurance scheme is being launched by Govt. of India and payment of premium is the proof of itself.  It is also stated that answering Ops are under no obligation to clarify the facts from Hospital and Police Station and the complainant is duty bound to provide the documents as required by answering Ops for processing the claim.  It is further stated that the claim of the complainant has not been processed due to non-fulfillment of basic requirements as prescribed under the PMSBY Scheme. Pleading no deficiency in service and denying all other allegations, the OPs No.1 & 2 have prayed for dismissal of the complaint.   

         OP No.3-United India Insurance Company Limited did not turn up despite service of notice sent through regd. post on 11.9.2019, hence OP No.3 was proceeded exparte vide order dated 03.12.2019.

   

3]       Parties led evidence in support of their contentions.

 

4]       We have heard the ld.Counsel for the parties and have perused the entire record.   

 

5]       At the outset, we would like to see the scope and basic purpose of the scheme in question (Pradhan mantra Suraksha Bima Yojana (PMSBY) (Ann.R-1), which clearly states as under:-

 

“The scheme is formulated by the Ministry of Finance, Govt. of India with an intention to helping insurance penetration to those who had no opportunity to get insured.”

 

6]       The statement of the complainant that they were never made aware about the documentary requirements of the scheme in question, as is demanded by the OPs in the instant case i.e. Copy of FIR and Postmortem Report, is acceptable.  The Opposite Parties have also admitted through letter dated 25.1.2019 (Ann.C-8) that no separate insurance policy was issued and deduction of amount itself is proof, which proves that complainant were never issued policy document nor terms & conditions thereof enabling the insured to know the documentary requirement under the policy.

 

7]       Further the insured person died within 3 months of accidental injuries for which he took treatment from Govt. Multispeciality Hospital, Sector 16, Chandigarh. The treatment documents placed on record by complainant as Ann.C-2 very well established that the insured person Ram Avtar was treated for Road side accidental injuries (RSA injury), injury to right hip. Therefore, it can be reasonably presumed that the injuries sustained during the accident could be a major factor leading to death of insured person. We cannot rule out the possibility that the insured had died as a result of accidental injuries. 

 

         More so, the said treatment (Ann.C-2) has not been denied or disputed by the OPs.  Further, the demand of OPs about any document for settling the claim under the policy, which was never brought to the knowledge of the insured by delivering policy document and terms & conditions thereof, is highly unfair & unjustified. The Opposite Parties never briefed the petitioner about the prerequisite conditions for disbursing the claim. Hence, we are of the considered opinion that the claim lodged by the complainant under the policy in question is genuine and justify.  Thus the OPs by not paying the genuine claim under the policy to the complainant have committed gross deficiency in service, which certainly has caused harassment, mental agony and loss to the complainant.   

     

8]       From the above discussion and findings, we are of the opinion that the deficiency in service on the part of OPs has been proved. Therefore, the present complaint stands allowed against OPs with direction to pay an amount of Rs.2 lacs to the complainants/her legal heirs being sum insured under the policy in question.  However, there is no order as to cost and compensation.

         This order shall be complied with by the Opposite Parties within a period of 30 days from the date of receipt of its certified copy, failing which they shall be liable to pay additional compensatory cost of Rs.15000/- apart from above relief.

         The certified copy of this order be sent to the parties free of charge, after which the file be consigned.   

Announced

19^th September, 2022                                                    sd/-             

 (PRITI MALHOTRA)

PRESIDING MEMBER

 

Sd/-

(B.M.SHARMA)

MEMBER